Buttles, John Perm VS No.61 NEW YORK
STATE DEPARTMENT OF HEALTH
ALBANY
OFFICIAL BURIAL (OR REMOVAL) PERMIT
110"'This Permit can be signed only by the Local Registrar(Deputy or Subregistrar)of the Primary Registra.
tion District (Town,Village, or City) in which the death occurred after the FILING and acceptance of aCOR-
RECT AND COMPLETE CERTIFICATE OF DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK.
Dist.No....!!'' //6 Q� Registered No
County Lf�A .__.. . ._.._.. Date of Death l 'J
cat A .._ ' � _.. g t!_y rs. ul
Sex_ a Color._
(Cross out names not applica.91/ • (Or Mos.
Cause of Death.__ ;
Place of Burial pia /12 Cemel' to of Burial_
(or Removal) ' " ter �_�.�c/J �A CERTIFICATE OF DEATH of _ ,rt=lil _ /rl/_
(Give.full name of deceas
having been presented to me containing above stated particulars,and,after careful examination,
the same appearing to be COMPLETE, ECT, AND SATISFACTORY AS REQUIRED BY
LAW,I have accepted the same for registration, have recorded it in my Local Record with
the ahoy tated Registers Number,and on th basis thereofkHEREBY GRANT A PERMIT
to 'J/ � - , CI:F � LJGf_.
(N of Un rtaker) -
(Address) .
the to ��� the body.
(Und aker or person ha ' charge of corpse) Int ove,or t i sp e of[s
Dated .r_.___4. Z. 1g_ 1 (Signed). __.
Local •strar
T Permit is sufficient for the Removal (and Interment or Cremation)of a b to any part of the
State (su ject to local cemetery or other regulations), provided,that where removal i y common carrier,
the above Permit must be included in the Transit Permit.
ENDORSEMENT OF SEXTON OR PERSON IN
CHARGE OF PREMISES ON WHICH INTER-
M TS OR CREMATIONS M�AD/F�
Date of ... . - f g,l Y r9.- ....
or cremat
(Signe ...-
(Person Aga
in charge)
(Name of Cemetery Crematorium,etc.),...,
Person in charge must return this Pe it to Registrar of his Dis ithin
SEVEN(7) DAYS from above date. If no person is in charge,the ER-
TAKER MUST SIGN ABOVE STATEMENT,write across the face of the Permit
the words"No person in charge,"and FILE PERMIT WITHIN THREE (3)
DAYS with Registrar of District in which cemetery is located.
EXTRACTS FROM LAWS OP r913,CHAPTER 619,ARTICLE so.
§ 379. Duties of undertaker. In each case the undertaker, or person
having charge of the corpse,shall file the certificate of death with the registrar
of the district in which the death occurred and obtain a burial or removal
permit prior to any disposition of the body. * * * The undertaker shall
deliver the burial permit to the person in charge of the place of burial, before
interring or otherwise disposing of the body; or shall attach the removal
permit to the box containing the corpse, when shipped by any transportation
company; said permit to accompany the corpse to its destination, where,if
within the state of New York,is shall be delivered to the person in charge
of the place of burial.
§ 380. Duties of undertake,; interment within the state. If the inter-
ment,or other disposition of the •ody is to be made within the state,the word-
ing of the burial or removal pe 't may be limited to a statement by the
registrar,and over his signature, '�-t a satisfactory certificate of death,having
been filed with him, as required b`s'law,permission is granted to inter,remove
or dispose otherwise of the body, sting the name, age, sex, cause of death,
and other necessary details upon • form prescribed by the commissioner of
health.
§ 381. Interments. No •- , in charge of any premises on which
interments or cremations are mad-"(all inter or permit the inteiment or other
disposition of any body unless it accompanied by a burial, cremation or
transit permit,as herein provided.,',uch person shall endorse upon the permit,
the date of interment, or cremat i over his signature, and shall return all
permits so endorsed to the registr A f his district within seven days from the
date of interment or cremate n. a`l ;hall keep a record of all bodies interred
or otherwise disposed of on ce pr.;',res under his charge,in each case stating
the name of e;ich„deceasedk 'ace of death, date of burial or disposal,
and name and address of t l e .i; t'ker; which record shall at all times be
open to official inspection, provi. that the undertaker or person having
charge of the corpse, when buryi t body in a cemetery or burial ground
having no person in charge, shall .n the burial or removal permit, giving
the date of burial,and shall write aer°-s the face of the permit the words,"No
person in charge,"and file the burial r removal permit within three days with
the registrar of the district in which he cemetery is located.
-SEXTONS and UNDERTAE ES violating the law relative to the re-
turn of permits are liable to a penalty of NOT LESS THAN FIVE DOLLARS
NOR MORE THAN FIFTY DOLLARS FOR THE FIRST OFFENSE. The
law will be enforced. Local Registrar's,are required,under penalty,to report
violations thereof.